title: Bladder exstrophy: Comparison of anatomical bladder neck repair with innervation preserving sphincteroplasty versus Young-Dees-Leadbetter bladder neck reconstruction.
abstract: OBJECTIVE
  To evaluate the outcome of innervation preserving sphincteroplasty along with anatomical bladder neck reconstruction (IPS-ABNR) compared to classic Young-Dees-Leadbetter (YDL) bladder neck reconstruction in exstrophy with insufficient bladder capacity requiring detubularized-ileocystoplasty.
  
  
  METHODS
  Sixteen male patients of exstrophy bladder who required ileocystoplasty from 2004 to 2010 were randomized into group A (n = 7) and group B (n = 9). After detubularized-ileocystoplasty with Mitrofanoff stoma and ureteric reimplantation in all, group A received YDL bladder neck repair while group B received IPS-ABNR repair through a midline scrotoperineal approach. Outcome measurement included operative and postoperative problems, continence, and upper tract status.
  
  
  RESULTS
  In group A, two had incompetent bladder neck with gross incontinence, while four had a dry interval of more than 3 h without the ability of voiding per urethra. In group B, seven patients had dry interval of more than 3 h with an ability of urethral voiding and midstream holding in five.
  
  
  CONCLUSIONS
  Exstrophy patients requiring augmentation cystoplasty and repaired with IPS-ABNR can achieve dynamic bladder outlet resistance with adequate leak point pressure and ability to void voluntarily with midstream holding capability. The children had the satisfaction of voiding per urethra with ability to stop in midstream similar to that in normal children.
authors.affiliation: Department of Pediatric Surgery, CSM Medical University (Earlier KGMC), Lucknow, Uttar Pradesh, India.
authors.forename: Archika
authors.initials: A
authors.lastname: Gupta
authors.forename: Shiv Narain
authors.initials: SN
authors.lastname: Kureel
authors.forename: Ashish
authors.initials: A
authors.lastname: Wakhlu
authors.forename: Jiledar
authors.initials: J
authors.lastname: Rawat
keywords: Anatomical bladder neck reconstruction; Young-Dees- Leadbetter bladder neck reconstruction; augmentation cystoplasty; exstrophy bladder; ileocystoplasty; innervation preserving sphincteroplasty